The acute stroke unit as transitional space: the lived experience of stroke survivors and healthcare practitioners

Abstract

The re-conceptualisation of stroke unit provision towards acute and hyperacute care has been a relatively recent development in the United Kingdom. This hermeneutic phenomenological study aimed to explore how the acute stroke unit (ASU) experience, as the phenomenon of interest, was meaningfully lived from a human lifeworld perspective. Eight participants: four stroke survivors and four healthcare practitioners: took part in semi-structured interviews, and if they agreed, an optional creative element. Interviews were recorded then transcribed. Detailed hermeneutic analysis drawing on interpretative phenomenological analysis (IPA) was undertaken firstly on each person’s account, and then across the collective from each perspective. An additional close textual reading was developed for one stroke survivor and one healthcare practitioner. A particular feature of the analysis was its influence in generating an innovative graphic interpretation of the research findings. The stroke survivors experienced the ASU as a lived space in two differentiated forms. The ASU holding space, through the spatial practices of nurses, and others, including similar others (patients), was understood to provide them with protection and safe haven; holding them intimately but also at a distance, so that they could think, make sense, plan and work towards transition. The transitional space of the ASU was experienced by three of them in more disparate ways, and represented how they transitioned their self (for protection, necessity and for recovery) in response to the stroke, the hospital space and the spatial practices of the ASU. The healthcare practitioners experienced the ASU as a space that they produced and appropriated for themselves and others. This was intertwined with their work as existential project; through their relationships with others, and their contribution to patients’ transitional work, they were understood to experience authenticity and belonging. This project was always in the making, and was undertaken amidst the day-to-day pressures on the unit. As a result, three of the health practitioners looked to make sense, navigate, and survive the vulnerability they experienced in relation to their meaningful work, as part of their ASU experience. Further synthesis of these two horizonal1 perspectives elucidated 3 key areas of new insight and understanding: the spatiality of the lived experience of the acute stroke unit, suffering and thriving as a human being, and the intertwining of multiple selves in time and place. The implications of this new knowledge for clinical practice, education, and research are further discussed in this thesis.

Date of Award	Jul 2017
Original language	English
Awarding Institution	University of Brighton